THE NOSE AND PARANASAL SINUSES
decongestants and steam inhalations. The patient is usually off work for a
further 2 weeks at the most.
Frontal Sinus. Operations on the frontal sinus are not commonly necessary
but will be required in the presence of continuing headache, or should there be
evidence of spreading infection.
Intranasal operations are rarely performed because the passage of catheters
or other instruments through the nasofrontal duct may result in stricture or
Fig. 33. Operation on the maxillary sinus
through the canine fossa wall (Caldwell-Luc).
The buccal incision.
Fig, 34. Operation on the maxillary sinus
(Caldwell-Luc). Opening in the canine fossa
wall, exposing to view the lateral wall of the
occlusion of the long duct, and this defeats the surgical aim of providing
External operation is more generally performed. The standard procedure
consists in making an external incision from beneath the supra-orbital
margin medial to the inner canthus and along the side of the nasal bridge
(Fig. 35A). The frontal sinus is entered near its floor (Fig. 35B), the opening is
enlarged and the diseased mucosa removed. The adjacent ethmoidal cells are
cleared to afford a wide drainage into the nasal cavity (Fig. 35C) and this is
kept patent by the insertion of a polythene tube of appropriate size. The
incision is closed and the sutures are removed in a week. The polythene tube is
removed at the same time or later. After-treatment is by nasal decongestants
and steam inhalations. The patient is in hospital for about 2 weeks and will be
off work for as long again. If much of the anterior wall has had to be removed
there may be an indentation in the forehead.
The osteoplastic flap operation has been devised to avoid this deformity
following surgery for chronic frontal sinusitis, and especially for the surgery
for osteoma of the frontal sinus. It is also used for a mucocele of the sinus or
if osteomyelitis develops. It consists in making a coronal incision behind the
frontal hair line and turning down the forehead skin and with it the anterior
wall of the affected sinus which is opened from its superior aspect. The
resulting scar is invisible, provided that the patient is not bald, and by preserv-
ing the anterior sinus wall there is no disfigurement.
Ethmoidal Sinuses. Chronic infection of the ethmoidal sinuses is often
accompanied by the production of nasal polypi, but infection may occur
Intranasal surgery of the ethmoidal cells is frequently performed during the
operation for removal of nasal polypi (Chapter 11). In the absence of nasal